Identifying and Engaging Urban HIV infected and uninfected YSMSM in care

摘要 目前的数据表明，在种族和少数民族中，新冠肺炎疾病和死亡的负担不成比例 在美国多个城市的1，2组(美国)黑人和拉丁裔人口比例不成比例 受新冠肺炎疾病和死亡的影响。1，3-5不成比例的比率很可能是伴随的 健康的共病和不利的社会决定因素，包括高药物使用率(SU)、精神疾病 健康、结构性种族主义、高人口密度、住房不足和难以获得健康食品。 健康的社会决定因素使社区容易患上新冠肺炎疾病，导致高 黑人和拉丁裔、性和性别少数族裔青年(15-24岁)的艾滋病毒感染率(SGMY)。新冠肺炎将 可能会加剧社会和经济不平等，这使黑人和拉丁人SGMY易患SU和HIV。 加剧的不平等也将导致艾滋病毒预防和治疗级联的进一步中断。 国家战略，结束艾滋病毒流行(EHE)，寻求诊断、治疗和预防#年的继续感染 受艾滋病毒影响最严重的社区，特别是黑人和拉丁裔SGMY。BLSGMY中物质使用率高12 已被确定为治疗和预防不接触的关键因素，13-15和增加物质 可能会在新冠肺炎大流行期间将其用作应对机制。引起19型冠状病毒的SARS-CoV-2， 优先攻击肺部，使吸食烟草或大麻的YBLSGMY，尤其有风险。 将使用顺序说明性混合方法设计，包括200个推送中的横断面调查 参与者(包括男性和女性参与者)(目标1)和48名参与者的质量数据和 他们的服务提供商(目标2-3)，以了解新冠肺炎疫情影响的潜在方式 个人生活环境、危险行为和求医行为；新冠肺炎的社区障碍 预防和治疗；以及应对机制，以解决在此期间经历的心理社会痛苦 时间到了。具体目标1：对200名参加PUSH的黑人和拉丁裔SGMY进行横断面调查 描述心理社会(包括学校停课、失业、心理健康和SU)中断和访问的特征 新冠肺炎造成的艾滋病毒预防、治疗和物质治疗服务障碍。具体目标2： 定性描述新冠肺炎造成的心理社会中断如何改变BLSGMY感染艾滋病毒的机会 预防、治疗和药物治疗服务以及用于处理干扰的应对机制。 具体目标3：在BLSGMY中找出治疗和预防新冠肺炎的潜在社区障碍 以及这种医疗不信任和错误信息的经历如何影响 BLSGMY的社会分裂经历。将使用配对深度访谈来探索潜在的障碍 BLSGMY和他们的提供者。这份补充资料让团队更好地了解新冠肺炎是如何 大流行病导致艾滋病毒预防、治疗和物质治疗服务机会有限； 潜在的社区障碍和出生时指定的性别如何改变这种关系。

ABSTRACT Current data suggest a disproportionate burden of COVID-19 illness and death among racial and ethnic minority groups.1,2 In multiple urban cities across the United States (U.S.) Black and Latinx persons are disproportionately impacted by COVID-19 illness and death.1,3-5 Disproportionate rates are likely the result of concomitant comorbidities, and adverse social determinants of health, including high rates of substance use (SU), mental health, structural racism, high population density, inadequate housing, and poor access to healthy foods.6,7 The same social determinants of health that predispose communities to COVID-19 illness, contribute to high rates of HIV in Black and Latinx sexual and gender minority youth (aged 15-24 ) (SGMY). COVID-19 will likely worsen social and economic inequalities, which predispose Black and Latinx SGMY to SU and to HIV. Exacerbated inequalities will also like result in further disruption of the HIV prevention and treatment cascades.8 The national strategy, Ending the HIV Epidemic (EHE), seeks to diagnose, treat and prevent onward infection in communities hardest hit by HIV, particularly Black and Latinx SGMY. High rates of substance use12 in BLSGMY has been identified as a key factor in treatment and prevention non-engagement, 13-15 and increased substance use may occur during the COVID-19 pandemic as a coping mechanism. SARS-CoV-2, which causes COVID-19, preferentially attacks the lungs, making YBLSGMY who smoke tobacco or marijuana, particularly at-risk.16-19 We will use a sequential explanatory mixed methods design, inclusive of cross-sectional surveys among 200 PUSH participants (both assigned male and female participants) (aim 1) and qualitative data of 48 participants and their service providers (aims 2-3), to understand potential ways in which the COVID-19 epidemic has affected personal life circumstances, risk behaviors, and health seeking behaviors; community barriers to COVID-19 prevention and treatment; and coping mechanisms to address psychosocial distressed experienced during this time. Specific Aim 1: Using a cross-sectional survey among 200 Black and Latinx SGMY enrolled in PUSH to characterize the psychosocial (including school closures, job loss, mental health and SU) disruptions and access barriers to HIV prevention, treatment and substance treatment services due to COVID-19. Specific Aim 2: Qualitatively describe how psychosocial disruptions due to COVID-19 alters BLSGMY’s access to HIV prevention, treatment and substance treatment services and the coping mechanisms used to address disruptions. Specific Aim 3: Identify potential community barriers to COVID-19 treatment and prevention among BLSGMY and their service providers and how such experiences of medical mistrust and misinformation impact experiences of social disruption in BLSGMY. Potential barriers will be explored using paired depth interviews of BLSGMY and their providers. This supplement allows the team to better understand how the COVID-19 pandemic contributes to limited access for HIV prevention, treatment and substance treatment services, and how potential community barriers and assigned sex at birth modifies this relationship.